Acute kidney injury in children hospitalized for community acquired pneumonia

Abstract

Background: Acute kidney injury (AKI) enhances the risk of later chronic kidney disease. Significant prevalence of AKI is reported in adults with community acquired pneumonia (CAP). We investigated prevalence of and prognostic factors for AKI in children hospitalized for CAP.

Methods: We retrospectively collected clinical and biochemical data of 186 children (48.4% male; mean age 2.6±2.4 years) hospitalized for X-ray-confirmed CAP. AKI was defined according to Kidney Disease/Improving Global Outcomes creatinine criteria. We considered as basal serum creatinine the value estimated with Hoste (age) equation assuming basal eGFR were median age-based eGFR normative values for children ≤ 2 years of age and eGFR= 120 mL/min/1.73m² for children > 2 years. Univariate and multivariate logistic regression models were used to explore associations with AKI.

Results: AKI was found in 38/186 (20.4%) patients. No patient required hemodialysis nor reached AKI stage 3, 5 (2.7%) reached AKI stage 2, and 33 (17.7%) AKI stage 1. Mean length of stay was 6.0±1.7, 6.9±2.3, and 12.2±1.5 days, for patients without AKI, stage 1 AKI, and stage 2 AKI (p < 0.001), respectively. Duration of symptoms before hospitalization (OR 1.2; 95%CI 1.09-1.43; p = 0.001), severe pneumonia (OR 11.9; 95%CI 4.3-33.3; p < 0.001), and serum C-reactive protein levels (OR 1.1; 95%CI 1.04-1.23; p = 0.004) were independent AKI predictors.

Conclusions: About 1/5 of children hospitalized for CAP present a generally mild AKI with a longer stay for those with more severe AKI. Attention should be paid to kidney health of children with CAP especially in presence of higher duration of symptoms before hospitalization, severe pneumonia and higher serum CRP levels.

Keywords: Acute kidney injury; C-reactive protein; Children; Community acquired pneumonia.

Fig. 1

Flow-chart describing patient enrolment

Fig. 2

Length of stay evaluated by Kaplan-Meier analysis. The cumulative proportion of discharge of patients without AKI was 1.3% at 2 days, 3.4% at 3, 16.9% at 4, 41.2% at 5, 64.9% at 6, 79.7% at 7, 91.2% at 8, 97.3% at 9, and 100% at 10 days. For the patients with stage 1 AKI, the cumulative proportion of discharge was 3.0% at 2 days, 12.1% at 4, 30.3% at 5, 51.5% at 6, 66.7% at 7 and 78.8% at 8, 93.9% at 10, 97.0% at 11, and 100% at 12 days. For the patients with stage 2 AKI, the cumulative proportion of discharge was 0% until 9 days, 60% at 12, 80% at 13 and 100% at 14 days. Log-rank test comparing the three Kaplan–Meier curves showed a global p < 0.001 (no vs. stage 1 AKI, p = 0.007; stage 1 vs. stage 2 AKI, p = 0.0003; no vs. stage 2 AKI, p < 0.0001)